The Dipper Status – Do We Really Need to Fight for It?

The idea of 24 hours blood pressure monitoring started more than 20 years ago [1] using semi-automatic devices, but even today we still need to inflate a cuff and listen to the Korotkoff sounds or to assess the maximum expansion of the artery when the pressure inside the cuff equals the mean blood pressure (the oscillometric method, used in actual ABPM devices). It is generally accepted that ABPM is a useful technique to evaluate the efficiency of the antihypertensive therapy, but there are more and more discussions about the relation between non-dipper status and cardiovascular risk.
The “dipper” status is defined by the European Society of Cardiology as a minimum of 10% decrease in the blood pressure [BP] during the night [2]. Patients without this BP dip are considered “non-dippers”, although more dipping profiles exist today (mild dippers, extreme dippers, reverse dippers, etc), even if those patterns are not easily reproducible [3]. Several published articles are suggesting that the non-dipper status is associated with increased cardiovascular risk [4, 5] especially in chronic renal disease patients [6] and some authors recommended changing the medication timing, in order to convert non-dipper patients to dipping status. [More]